Surgical treatment of inflammatory bowel disease
Inflammatory bowel diseases are of chronic nature and their etiology is not fully known. During the first stages of the disease the gastroenterologists stick to conservative treatment, but how to deal with the disease when it worsens and significantly diminishes the patient’s quality of life? Prof. Oded Zmura, a leading colorectal surgeon at Herzliya Medical Center, tells us about surgical treatment of inflammatory bowel disease, when it is suitable and what kind of surgery is performed in cases of ulcerative colitis and Crohn’s disease.
Treatment of inflammatory bowel disease
Inflammatory bowel diseases are divided into two major groups: ulcerative colitis and Crohn’s disease. These conditions cause an inflammation in the digestive system, causing the patient suffering and often accompanied by complications. The main target of surgical treatment for these conditions is bringing the disease to a remission and improving the patient’s quality of life. Also, surgery is often the only way to treat complications of the disease. It is important to understand that conservative drug therapy and surgery do not exclude each other, but go hand in hand.
Surgery for ulcerative colitis
Surgery for ulcerative colitis is done when:
- The conservative drug therapy is ineffective
- There are signs of a high risk of malignization. For example, dysplasia of the bowel’s mucous tissue.
Surgery for ulcerative colitis, usually, entails total resection of the colon and rectum (total proctocolectomy), followed by forming a pouch from the small intestine, which is then connected to the anus (anastomosis). This is a complicated procedure that requires very strict and constant follow-up after the surgery.
Surgery for Crohn’s disease
Surgery for Crohn’s disease is done when:
- The disease does not respond to conservative drug therapy and remission is not achieved
- There are complications of the disease in the form of bowel stricture or forming of fistulas
Surgery for Crohn’s disease, usually, entails resection of the whole inflamed part of the bowel. It is important to remove enough of the bowel tissue to cause remission, but also to leave enough of the bowel tissue to allow another surgery in case of a recurrent complication. In some cases bowel stricture can be surgically treated without resection, this procedure is called stricturoplasty.
Sometimes Crohn’s disease spreads to the anus, causing recurrent abscesses and fistulas, and with it a lot of suffery to the patient. These patients need surgical drainage that usually entails the use of Seton’s drain. After thorough drainage combined with drug therapy, biological glue and collagen implants can be used to treat the fistulas without damaging the anal sphincter muscle tissue.
Surgeries for inflammatory bowel diseases are complicated procedures that require a highly qualified colorectal surgeon with a vast experience in the field. Before performing the surgery a consilium of surgeons gets together and decides on a concrete plan of treatment. The surgery is performed by two specialists.
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